Ethical Knowing in Nursing
Blogs by Marsha Fowler

Isaiah 10.
1 Woe to those who make unjust laws,
    to those who issue oppressive decrees,
² to deprive the poor of their rights
    and withhold justice from the oppressed of my people,
making widows their prey
    and robbing the fatherless.
³ What will you do on the day of reckoning,
    when disaster comes from afar?
To whom will you run for help?
    Where will you leave your riches?
⁴ Nothing will remain but to cringe among the captives
    or fall among the slain.

The governmental proclivity for the oppression of the poor and deprivation of the human and civil rights of the poor and vulnerable in society is a well established modus operandum. The words above are from the book of Isaiah, in the proto-Isaiah chapters (1-39), dated from the eighth century before the common era.  Social injustice was a grievous sin for which Kings and Overlords  would be held to account.  While injustice and oppression was a sin against the people, it was also a sin against God, for it was and is a form of idolatry.  Idolatry was an affront to God because it prized power, wealth, and status — the temporal and transient — over compassion for and the care of vulnerable persons and the common good.  Idolatry invariably led to injustice, violence, tyranny, oppression, marginalization of others, and actions that selfishly furthered one’s own desires and ends.

But now, twenty-nine centuries later, what is the day of reckoning of which Isaiah speaks?  Who will make the oppressor cringe and fall? The day of divine reckoning is at some future accounting, likely not this day. But an accounting for oppression, injustice, and denial of rights, and harm to those who have no power belongs to this day.  Now and imperatively.  It is a matter of life and democracy that has a claim to participation by all society’s members. 

In our democracy of checks and balances the three arms of government, (legislative, administrative, and judicial), are responsible for holding one another accountable.  However, the actual day of reckoning resides with the people, at the ballot box and in their activism that informs the three branches of government of the will of the people.  And yet, in matters of health and wellbeing, the people have entrusted the responsibility for the functions of preserving health and wellbeing to those educated in the heath sciences.  Society has, thus, authorized a health discipline called “nursing” and entrusts nursing with the care of its members in sickness and in health and when in death they do depart.

Nursing participates in a social covenant where society is responsible for sustaining and safeguarding the profession in various ways, and the profession is responsible for providing knowledgeable, skilled, ethical, and compassionate care to all the members of society, individually and collectively.  Nursing has done so, with honor, and has for many years been regarded as the nation’s most honest profession, or trusted, as some say.

That trust is now being tested. Our health structures and the health sciences and health research (NIH, CDC) are being decimated, and have suffered considerable damage. The plans to starve the NINR, the severance of funding to US-lead programs for global health (through USAID), and the withdrawal from the WHO, the regulatory changes that undermine the health of the planet upon which human, animal, and plant life depends; the impending destruction about to be visited upon Medicare, Medicaid, and the Veteran’s Administration that provide health and medical services to huge segments of the population; the cuts to family, food, and mental health programs; the anti-science health disinformation being perpetrated and perpetuated — all these and more lay claim to a response from nursing and nurses, a claim to respond to the injustices and health damaging consequences of our government’s actions. Not to act is a betrayal of our covenant responsibilities, and a betrayal of the trust society has vested in us.

It is also a betrayal of our Code of Ethics for Nurses in terms of patient care (provisions 1-3), in terms of the continuing advance of nursing knowledge (provisions 4-7), and most specifically in terms of provisions eight, nine, and ten which specify the profession’s relationship with national and global health.

Provision Eight calls nursing to collaborate with other health professions to achieve ends that nursing cannot achieve on its own. When we speak out, we need not do so alone.  Provision Nine says:

Nurses and their professional organizations work to enact and resource practices, policies, and legislation to promote social justice, eliminate health inequities, and facilitate ­ human flourishing.

Provision Ten says:

Nursing, through organizations and associations, participates in the global nursing and health community to promote ­ human and environmental health, well-being, and flourishing.

The day of reckoning is at hand for those who are dismantling the health of the nation and world.  But the day of reckoning is also at hand for nursing.  Will nursing live up to or betray the social trust that it has earned over the past 150 years?  Will nurses and nursing live into the Code of Ethics? Will nursing fulfill its covenantal obligations even as the current administration actively subverts its own mandate?  We nurses, and nursing organizations, cannot and must not betray our ethics and our covenant with society.  We must act individually, collectively, and with other health professionals, and do so as if life depended upon it.  It does.